A Case-Based Review on the Diagnosis and Treatment Options for Recurrent Wheezing and Asthma in Preschool Children

Abstract

To summarize the recent evidence on the various wheezing patterns in early life and provide a case-based review with insights into clinical application of individualized therapy in preschool children with recurrent wheezing. Preschool wheezing is often characterized predominantly by the risk domain with exacerbations and relatively limited impairment. In children with intermittent disease and a positive Modified Asthma Predictive Index, intermittent therapy with inhaled corticosteroids (ICSs) should be considered as an initial therapy to prevent exacerbations. Early administration of azithromycin at the onset of lower respiratory tract infections (LRTIs) reduces the risks of progression to severe illnesses in children who have a history of recurrent severe LRTIs, and more information is needed regarding the risks of developing drug-resistant organisms. In preschool children with mild persistent asthma, allergic sensitization to aeroallergens and absolute eosinophil count can help identify children most likely to have a good response to daily ICS. Recent clinical trials in preschool children with severe episodic wheezing and persistent asthma have made a significant impact on the approach for the care of these children, particularly with evidence directing individualized approaches based on specific clinical features and biomarkers.